| Question | Answer | Hint |
| Normal functioning of the lungs depends on what three factors? | patent respiratory tree, functioning alveoli system, well functioning cardiovascular system | |
| What is meant by a patent respiratory tree? | open, able to move air. If there is an occlusion or obstruction it is not patent and will have a negative impact on the respiratory sys. | |
| What is the main function of the upper airway? | warms air, humidifies, filters air, and helps get microorganisms out | |
| What are cilia and what are their main function? | hair like projections in the airway that help get contaminants out of the respiratory tree. | |
| What are the functions of mucus and coughing? | Mucus helps to capture microbs while coughing helps move secretions out. | |
| What helps to thin mucus in the lungs? | Hydration | |
| What is the function of surfactant? | helps to keep the alveoli open/inflated and decreases surface tension | |
| What is ventilation? | the movement of air in and out of the lungs | |
| define/describe inhalation | active process, muscles contract, diaphragm moves down, pressure goes down and air rushes in | |
| define/describe exhalation | passive process, muscles relax, diaphragm moves up, pressure goes up and air rushes out | |
| What are 3 factors that affect respiration? | Accessory muscles, lung compiance, and airway resistance | |
| What are the accessory muscles and what do they do? | They are the abdominal, intercostal, and sternocleidomastoid muscles which help the distressed pt. move air | |
| What is lung compliance? | elasticity of lungs to expand; how easily the lungs expand. Decreased lung compliance means decreased elasticity | |
| What factors affect lung compliance? | chest wall factors (position of the body-MS, obesity, lying in bed, etc.) and lung factors (problems in the lungs- pneumonia, fibrosis, pulmnary edema, etc.) | |
| What is atelectasis? | decreased expansion of the lungs | |
| What is pleural effusion? | collection of fluid between lung and chest wall. Fluid collapses the lungs. | |
| What is pulmonary edema? | fluid inside the respiratory tree such as with lf. side heart failure- blood gets backed up into the lungs and dumped into the alveoli because heart can’t pump it out properly. | |
| What is pulmonary fibrosis or pulmonary htn? | after an injury occurs fibrin and collagen are laid down to repair which toughens lung tissue and decreasing compliance | |
| What is pneumothorax? | a collapse of a portion of lung with air in the pleural space | |
| What is hemothorax? | blood in the pleural space | |
| What can cause airway resistance? | any obstructions to airflow: narrowed tube, tumor, infection, secretions, edema, foreign objects, bronchial constriciton, etc. | |
| define diffusion | movement of SOLUTES from an area of greater concentration to an area of lesser concentration | |
| define osmosis | movement of SOLVENT from and area of lesser concentration to an area of greater concentration | |
| define perfusion | movement of fluid (blood) through or into a system (blood entering vessels through walls) | |
| Diffusion and perfusion are interrelated, therefore can you have one without the other? | Yes, it is possible to have diffusion but not perfusion however diffusion will not be effective. For example air is moving into the lungs, but there is a blocked area of tissue so perfusion is not happening | |
| What things effect diffusion in the lungs? | surface area (less area = less diffusion), disease, and a decrease in environmental O2 | |
| What types of things can affect the amount of surface area in the lungs? | body position, tumor, lung collapse, lung removal, muscus plug, immobility, etc. | |
| How is oxygen transported through the body? | 97% is attached and transported via hemoglobin and 3% is dissolved into plasma | |
| The amount of oxygen that binds to hgb depends on what? | PaO2 : more PaO2 the more oxygen that attached to Hgb | |
| What is a normal PaO2? | between 80-100mmhg | |
| At a PaO2 of 60mmhg how saturated are the Hbg with oxygen (SaO2)? | 90% | |
| What is hypoxemia? | decreased O2 in blood and causes hypoxia | |
| What is hypoxia? | decreased O2 in the tissues | |
| What are some sx/s of hypoxia? | cyanosis, pale coloration of skin, apprehensive, restless, confused, c/o dyspnea | |
| What controls respirations in a healthy person? | CO2: CO2 crosses the bbb and mixes with H2O. H+ ions increase which causes faster breathing. | |
| What controls respriation in a nonhealthy person? | O2 : since a nonhealthy person lives with high levels of CO2 because of the build up, O2 must therefor control the respiratory drive. Low levels of O2 increases breathing | |
| Why is it important to monitor a pt. with COPD who is on oxygen? | Because if the O2 levels get too high then their respriatory drive is not triggered and the pt. can stop breathing | |
| What are two ways of measuring O2 in the blood? | ABG (arterial blood gas) and Pulse oximeter (saturation of O2) | |
| What are the normal ranges of PaO2 and PaCO2? | PaO2:80-100mmhg PaCO2:35-45mmhg | |
| What does and ABG tell us? | How well diffusion is functioning in the lungs | |
| What would a venus draw(VBG) tell us? | how much O2 is being used by the tissues; tells us the O2 demand in the peripheries | |
| True or false?ABG will help us make critical decisions and tells us if the pt. needs O2 therapy. | True | |
| What is a normal level on a pulse ox? | 95-100% but anything over 90% is good | |
| True or false? pulse ox will help us make critical decisions and tells us if the pt. needs O2 therapy. | False. It does not help make critical decisions, but may determine if a ABG is needed | |
| How can a pulse ox give a misreading of O2 saturation? | If Hgb is low but still 90% saturated it could read 90%SaO2 when the pt. is actually hypoxic or hypoxemic because of the low Hbg levels | |
| What types of pts need O2 therapy? | if they are hypoxic or hypoxemic, someone with a non-respiratory problem and demands more O2 to the tissues such as a febrile pt, someone with low levels of Hgb such as with blood loss or burn victims, someone with reduced O2 carrying ability such as a post-op pt, someone with decreased cardiac output | |
| What is the % of O2 (fraction of inspired air FiO2) in room air? | 21% | |
| True or false? If over 2L/min of O2 is delivered then it needs to be humidified. | True | |
| True or false? you need a dr. order to humidify but not to administer O2. | False. Oxygen is considered a drug and you need a dr.s order for it however you do not need an order to humidify | |
| Up to how many L of O2 can be given with nasal prongs? | 6L/min | |
| simple face mask | delivers 5-8L/min O2, 40-60% FiO2, fits snugly, has vents to pull in room air and expel CO2 | |
| Partial rebreather | has reservoir bag and vents, needs humidity, delivers 5-11 L/min O2, 60-75% FiO2, | |
| Non-rebreather | same as partial rebreather except it has vents, prevents outside air and exhaled CO2 from mixing with O2, needs to be monitored, delivers 6-15 L/min O2, 80-90% FiO2 | |
| Venti mask | only delivers up to 50% FiO2 but is more accurate than other masks because you can control the amount of O2 and room air that is given | |
| What are 5 precautions when using oxygen? |
|
Showing posts with label Airway Assessment. Show all posts
Showing posts with label Airway Assessment. Show all posts
Mar 7, 2015
Cardiac System Oxygenation Help....
Cardio – Oxygen Questions Study Guide
Some Oxygenation Questions, Interventions....
Pneumothorax, Crushed Chest, Gunshot, Stab Wounds....
A chest tube is put in a pt’s chest when the pt has a pneumothorax because? It removes air from the pleural space which reinflates the lung by reestablishing negative pressure – know it is reinflated when nurse hears breath sounds
Crepitus- air trapped in tissues that crackles
When is a chest tube not used? For pneumonectomy
Following a right pneumonectomy, the pt is cool and clammy, resp. are labored, his skin is pale, he sits straight up in bed? What does the nurse do? Auscultates the left lung – a mediastinal shift with airway obstruction may occur b/c pressure builds up on the operative side, causing the trachea to deviate toward the unoperative side; ASSESSMENT of the airway takes priority
What should the nurse do first when a pt wakes after a pneumonectomy? Encourage deep breathing – helps keep the airway patent and prevents atelectasis of the remaining lung by raising intrapleural pressure
What positions should the pt be in following a right pneumonectomy? Supine or right side-lying position – permit ventilation of the remaining lung and prevent fluid from draining into the sutured bronchial stump
What should the nurse look for in a pneumonectomy pt? signs of cardiac overload
The best coughing routine for a pneumonectomy pt is? Q hr for 1st 24 hrs then q 2 hrs
Pt has ph of 7.32, Pco2 of 53 and hco3 of 25. What should the nurse do? Encourage the client to cough productively and take deep breaths-resp. acidosis can be caused by the depressant effects of anesthesia or a partially obstructed airway; these activities clear the airway and blow off CO2
If a water chamber in the pleu-evac stops fluctuating, the nurse should? Look for obstructions in the tube, the water should rise and fall with breathing, called tidaling
How does a nurse measure and document the amt of drainage from a chest tube? Mark the time and fluid level on the outside of the drainage chamber of the closed chest drainage system
What is happening when a water-sealed drainage system has excessive bubbling? Check the system for air leaks
When a gunshot pt is expected in the ER, what equipment should be prepared? Chest tube equipment because the priority is to stabilize the respiratory status
In a crushing chest injury, what shows that treatment is working? Increased breath sounds, chest tube normalizes intrathoracic pressure, drains fluid and air from the pleural space and improves pulmonary function.
What to do when a pt pulls out a chest tube? Cover wound with cleanest material available, resp status is priority over risk for infection
When a chest tube separates from the drainage system what should the nurse do? Reconnect it immediately to prevent pneumothorax
Why does a trach need suctioning? It interferes with the ability to cough effectively
What is highest priority assessment for a pt with a crushing chest wound? Quality of respirations and presence of pulses –
What is the treatment for hypoxia among postop pts, when the pt complains of chest pain and shortness of breath? O2 – supplemental O2 supports the body while the cause of the problem is sought; O2 support is the first therapy in all cases of hypoxia and can be instituted without a physician’s order in an emergency
The primary responsibility of the nurse when caring for a client with a chest tube attached to a 3 chamber underwater seal drainage system would be to? Maintain the closed system – an airtight system is needed to reestablish negative pressure and reinflate the lung
A pt with a left chest stab wound should be positioned how? Left side with head elevated – needs to lay on the affected side so they unaffected lung can expand to its fullest potential, elevation of the head facilitates respirations by reducing the pressure of the ab organs on the diaphragm and allowing the diaphragm to descend with gravity
When assessing a stab wound pt the 1st priority is? quality of depth of respirations, – should evaluate unilateral chest movements that may indicate pneumothorax and tachypnea, which are associated with hypercapnia and acidosis
Respiratory Surgery Interventions and Questions....
Why should the nurse withhold food from a pt following a bronchoscopy? Aspiration – no gag reflex, to test for return of gag reflex, should touch pharynx with depressor.....
After a laryngectomy a pt can develop frequent coughing and copious secretions due to lack of warmed, moist air.
A good nursing intervention after surgery to promote adequate ventilatory exchange would be to? Position the client laterally with neck extended. The tongue will not obstruct the airway
Priority after a laryngectomy is? Keep the trach free of secretions – patent airway is priority
Can a pt with a total laryngectomy and radical neck dissection still chew and swallow? Yes
A pt has moderate edema of the neck tissues after a radical neck dissection. The nurse should assess for? Restlessness and dyspnea because this pt is at risk for airway obstruction, and these signs may indicate hypoxia
What are some interventions for pt with radical neck surgery? Chest tube to drain fluid, total Parenteral nutrition and bed rest. TPN provides nutrition, boosts immune defenses, and decreases thoracic duct flow, bed rest b/c lymphatic flow increases with activity
The reason to perform deep breathing exercises after surgery is to help with? Counteracts respiratory acidosis, retention of CO2 in the blood lowers the Ph, causing resp. acidosis; deep breathing maximizes gaseous exchange, ridding the body of excess CO2
A common early sign of laryngeal cancer for which the nurse should assess a client would be? Hoarseness –
What is the purpose of the third chamber in the 3 chamber underwater drainage system? It controls the amount of suction – 1st collects drainage, 2nd provides for the seal, 3rd –controls amt of suction
What is the top priority when a client is unconscious? An obstructed airway, reduced O2 intake may lead to serious complications
A pt has an unresolved hemothorax and is febrile, with chills and sweating. He has a nonproductive cough and chest pain. His chest tube drainage is turbid. He could be experiencing? Empyema, an accumulation of pus in a body cavity which is a result of bacterial infection. Turbid drainage is the hallmark sign
A client with supraglottic cancer undergoes a partial laryngectomy. Postop, a cuffed trach tube is in place. When removing secretions that pool above the cuff, the nurse should instruct the client to? Cough as the cuff is being deflated, if cannot cough then the nurse should suction
A good nursing intervention after surgery to promote adequate ventilatory exchange would be to? Position the client laterally with neck extended. The tongue will not obstruct the airway
Priority after a laryngectomy is? Keep the trach free of secretions – patent airway is priority
Can a pt with a total laryngectomy and radical neck dissection still chew and swallow? Yes
A pt has moderate edema of the neck tissues after a radical neck dissection. The nurse should assess for? Restlessness and dyspnea because this pt is at risk for airway obstruction, and these signs may indicate hypoxia
What are some interventions for pt with radical neck surgery? Chest tube to drain fluid, total Parenteral nutrition and bed rest. TPN provides nutrition, boosts immune defenses, and decreases thoracic duct flow, bed rest b/c lymphatic flow increases with activity
The reason to perform deep breathing exercises after surgery is to help with? Counteracts respiratory acidosis, retention of CO2 in the blood lowers the Ph, causing resp. acidosis; deep breathing maximizes gaseous exchange, ridding the body of excess CO2
A common early sign of laryngeal cancer for which the nurse should assess a client would be? Hoarseness –
What is the purpose of the third chamber in the 3 chamber underwater drainage system? It controls the amount of suction – 1st collects drainage, 2nd provides for the seal, 3rd –controls amt of suction
What is the top priority when a client is unconscious? An obstructed airway, reduced O2 intake may lead to serious complications
A pt has an unresolved hemothorax and is febrile, with chills and sweating. He has a nonproductive cough and chest pain. His chest tube drainage is turbid. He could be experiencing? Empyema, an accumulation of pus in a body cavity which is a result of bacterial infection. Turbid drainage is the hallmark sign
A client with supraglottic cancer undergoes a partial laryngectomy. Postop, a cuffed trach tube is in place. When removing secretions that pool above the cuff, the nurse should instruct the client to? Cough as the cuff is being deflated, if cannot cough then the nurse should suction
Oxygenation of your Patient and Lung Function Interventions....
ARDS = Acute Respiratory Distress Syndrome
Pt w/intubation & PEEP = assess response Pt w/ heart failure and crackles = High Fowlers – promotes lung expansion & gas exchange, decreases venous return and cardiac workload Problem w/ pneumonectomy = ventilory exchange O2 & CO2 exchange is a priority Obese pt, smoker, major abdomen surgery. Postop what is priority? – O2 stats To monitor for s/sx of hyperventilation monitor for? – resp. alkalosis – increase rate and depth of breathing results in excessive elimination of CO2 Where do you hear stridor? Over the trachea or larynx Good breathing exercise is? Breathe from abdomen – improves lung expansion What to do with condensation collecting in the vent tubing? Empty the fluid from tubing – What to do in ER when trach is expelled? Hold open with tracheal dilator and call for help Pt is in pain on right side of chest, is dyspneic and coughs violently after abd surgery, nurse should? Elevate head of bed – may be pulmonary embolus and this promotes breathing by reducing the pressure of the abd. Organs on the diaphragm and increasing thoracic excrusion What can suctioning cause and what to do about it? Can cause dysrhythmias so hyperoxygenate prior to, during and after suctioning If nasogastric feedings are required in a pt with trach what should the nurse do with the cuff? Inflate the cuff before and for 30 min after ea feeding
A trach tube with high vol., low-pressure cuff is used to prevent? Mucosal necrosis – these cuffs do not compress the capillary beds and thus do not cause trach damage
emphysema pt is using accessory muscles to breathe, his dyspnea is caused by? Difficulty expelling the air trapped in the alveoli – these pts use these muscles to breathe
A pt with a PCO2 of 60 needs? Mechanical ventilation – this indicates progressive resp. failure, vent. Support is needed when the Pco2 is above 40
A lung cancer pt hooked to chest tube for drainage. Nurse should report what to physician? Subcutaneous emphysema on the 2nd day – evidence of a leak from the chest tube or the lung into the subq tissue
A pt presents to ER after being hit in chest with a baseball. X-ray shows pneumothorax. What does nurse find on assessment? An absence of breath sounds on auscultation – collapsed lung
Pt w/intubation & PEEP = assess response Pt w/ heart failure and crackles = High Fowlers – promotes lung expansion & gas exchange, decreases venous return and cardiac workload Problem w/ pneumonectomy = ventilory exchange O2 & CO2 exchange is a priority Obese pt, smoker, major abdomen surgery. Postop what is priority? – O2 stats To monitor for s/sx of hyperventilation monitor for? – resp. alkalosis – increase rate and depth of breathing results in excessive elimination of CO2 Where do you hear stridor? Over the trachea or larynx Good breathing exercise is? Breathe from abdomen – improves lung expansion What to do with condensation collecting in the vent tubing? Empty the fluid from tubing – What to do in ER when trach is expelled? Hold open with tracheal dilator and call for help Pt is in pain on right side of chest, is dyspneic and coughs violently after abd surgery, nurse should? Elevate head of bed – may be pulmonary embolus and this promotes breathing by reducing the pressure of the abd. Organs on the diaphragm and increasing thoracic excrusion What can suctioning cause and what to do about it? Can cause dysrhythmias so hyperoxygenate prior to, during and after suctioning If nasogastric feedings are required in a pt with trach what should the nurse do with the cuff? Inflate the cuff before and for 30 min after ea feeding
Subscribe to:
Posts (Atom)